Organization
MT ANESTHESIA SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL THOMAS SICKAFUS CRNA (PRESIDENT)
(724) 301-3017
Entity
Organization
Contact information
Practice address
616 VICTORY DR, SHARPSVILLE, PA 16150-1718
(724) 301-3017
Mailing address
616 VICTORY DR, SHARPSVILLE, PA 16150-1718
(724) 301-3017
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN340704L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2371375
—
OH
Enumeration date
09/17/2009
Last updated
09/17/2009
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